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Kaan Kirali
Kosuyolu Heart Center, Cardiovascular Surgery, Faculty Member
- Ttedit
Ten months after an ineffective percutaneous coronary stent placement, a 53-year-old patient was rehospitalized with NYHA functional class IV congestive heart failure, ischemic heart disease and left ventricular aneurysm. Echocardiography... more
Ten months after an ineffective percutaneous coronary stent placement, a 53-year-old patient was rehospitalized with NYHA functional class IV congestive heart failure, ischemic heart disease and left ventricular aneurysm. Echocardiography revealed thrombus formation in the left ventricle with apical aneurysm. Even though left ventricular assist device (LVAD) implantation improves quality of patients’ lives with an increase of its overall use, it becomes more complicated in the presence of ventricular thrombus. We decided to perform ventricular reconstruction with thrombus extraction concomitant to HeartMate 3™ LVAD implantation. The patient was recovered uneventfully, and discharged on postoperative day 14. This report shares the patient’s case and the surgical procedure.
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We present a retrospective analysis of three cases of cardiac hydatidosis, who underwent surgery between 2010 and 2012. Two patients had a lesion in the interventricular septum, whereas one patient had the lesion in apicoinferior wall of... more
We present a retrospective analysis of three cases of cardiac hydatidosis, who underwent surgery between 2010 and 2012. Two patients had a lesion in the interventricular septum, whereas one patient had the lesion in apicoinferior wall of LV. The diagnosis was made by echocardiography, but magnetic resonance imaging was utilized to assess cyst activity and extend of disease. All patients were placed on cardiopulmonary bypass. No postoperative complication or death occurred. The patients discharged uneventfully and all of them were free from hydatid disease at two years follow-up. We concluded that cardiac hydatid cysts should be removed surgically regardless of their location or extent, even in asymptomatic patients.
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... Özet. Amaç: Aortanın ana yan dallarını ilgilendiren arteriyovenöz fistüller yüksek debili refrakter kalp yetmezliğine yol açabildikleri gibi, cerrahi onarımları sırasında görülebilecek ciddi kanamalarla ölümcül de seyredebilirler. ...
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... tranesophageal echocardiography. Echocardiography 1996;13:635-8. 6) Sarıoğlu A. Konjenital kalp anomalilerinde kardiyak morfolojinin segmental analizi ve ekokardiyografik tanısı. T Klin Kardiyol 2003;3:135-50. 7) Albes ...
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... 2 Murat Güçlü Elevli, 3 Kaan Kırali, 4 Denyan Mansuroğlu, 5 Gökhan İpek, 1 Cevat Yakut 4. 1 İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul 2 Mayo Clinic, Cardiothoracic Surgery,... more
... 2 Murat Güçlü Elevli, 3 Kaan Kırali, 4 Denyan Mansuroğlu, 5 Gökhan İpek, 1 Cevat Yakut 4. 1 İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, İstanbul 2 Mayo Clinic, Cardiothoracic Surgery, Rochester, MN, ABD 3 Özel Konak Hastanesi ...
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IntroductionOn March 10, the first case of coronavirus disease 2019 (COVID-19) was reported in Turkey; in the meantime, over 95 million confirmed cases with more than 2 million deaths have been reported worldwide. Case PresentationAfter... more
IntroductionOn March 10, the first case of coronavirus disease 2019 (COVID-19) was reported in Turkey; in the meantime, over 95 million confirmed cases with more than 2 million deaths have been reported worldwide. Case PresentationAfter the identification of first COVID-19 (+) patient, our center conducted the management of selection and treatment of candidates and continued to perform cardiac transplantations. We herein present two cases after determination of patient zero in Turkey in order to highlight clinical implications by describing our clinic principle in the ethical knowledge of ISHLT COVID-19 Task force statement regarding heart transplantation (HTx).ConclusionsCOVID-19 creates a challenge on donor selection and post-transplant management and immunosuppressive therapy. And, a question arises about continuing HTx due to risk of immunosuppressive therapy, as well as exposure during hospitalization.
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Access from the femoral arteries to the thoracic aorta for intra-aortic balloon pump (IABP) insertion may not be feasible in a substantial number of patients with severe peripheral vascular disease. Since using an alternative access is... more
Access from the femoral arteries to the thoracic aorta for intra-aortic balloon pump (IABP) insertion may not be feasible in a substantial number of patients with severe peripheral vascular disease. Since using an alternative access is inevitable in a certain number of patients requiring IABP support, all alternative accesses should be added to the surgical armamentarium. Herein, we present our 27-year experience with different alternative accesses for IABP insertion following failed contraindication to femoral artery cannulation. The alternative techniques described below were: transthoracic insertion with a tube graft, transthoracic insertion – direct, transaxillary/subclavian insertion and transbrachial insertion.
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Aort kökü cerrahisinde proksimal anastomozun posterior sütür hattından ve sol koroner arter buton anastomozundan meydana gelebilecek kanamalar özellikle kros klemp kaldırıldıktan sonra ciddi zorluklara yol açarak mükemmel bir cerrahi... more
Aort kökü cerrahisinde proksimal anastomozun posterior sütür hattından ve sol koroner arter buton anastomozundan meydana gelebilecek kanamalar özellikle kros klemp kaldırıldıktan sonra ciddi zorluklara yol açarak mükemmel bir cerrahi prosedürü bozabilir. Biz burada distal ...
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... Ven greftlerinde aterotrombotik tıkayıcı hastalığın daha hızlı seyretmesi, uzun dönemde açıklık oranlarının arteryel greftlere oranla daha düşük olmasına neden olmaktadır.[1] Sol internal mammaryan arterin (LİMA) sol ön inen arter... more
... Ven greftlerinde aterotrombotik tıkayıcı hastalığın daha hızlı seyretmesi, uzun dönemde açıklık oranlarının arteryel greftlere oranla daha düşük olmasına neden olmaktadır.[1] Sol internal mammaryan arterin (LİMA) sol ön inen arter (LAD) anastomozu için altın standart olduğu ...
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... Risk faktörlerinin erken dönem mortaliteye etkisi ile üre ve kreatinin yüksekliğine yol açan faktörler istatistik incelemeye tabi tutuldu. ... Enfeksiyona yol açan başlıca faktörler ileri yaş, diabetes mellitus ve femoral bölgeye... more
... Risk faktörlerinin erken dönem mortaliteye etkisi ile üre ve kreatinin yüksekliğine yol açan faktörler istatistik incelemeye tabi tutuldu. ... Enfeksiyona yol açan başlıca faktörler ileri yaş, diabetes mellitus ve femoral bölgeye anastomoz yapılması olarak saptandı. ...
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Hastane mortalitesi 9 hasta ile %32.1 idi. Ölüm nedenleri düşük kalp debisi, akut tubuler nekroz, erişkinde sıkıntılı solunum sendromu, multi-organ yetmezliği, aşırı kanama ve serebrovasküler olay idi. Tüm hastalar için erken mortaliteyi... more
Hastane mortalitesi 9 hasta ile %32.1 idi. Ölüm nedenleri düşük kalp debisi, akut tubuler nekroz, erişkinde sıkıntılı solunum sendromu, multi-organ yetmezliği, aşırı kanama ve serebrovasküler olay idi. Tüm hastalar için erken mortaliteyi etkileyebileceği düşünülen 18 değişken ...
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A 65-year-old man with unstable angina pectoris developed malaria prior to coronary artery bypass grafting. After 3 weeks on antimalarial therapy, left internal mammary artery-toleft anterior descending artery anastomosis was performed on... more
A 65-year-old man with unstable angina pectoris developed malaria prior to coronary artery bypass grafting. After 3 weeks on antimalarial therapy, left internal mammary artery-toleft anterior descending artery anastomosis was performed on the beating heart to avoid the effects of cardiopulmonary bypass. There was no complication in the early postoperative period.
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... Can J Cardiol 2005;21:159-63. 13) Grant SC, Khan MA, Faragher EB, Yonan N, Brooks NH. Atrial arrhythmias and pacing after orthotopic heart transplantation: bicaval versus standard atrial anastomosis. Br Heart J 1995;74:149-53. ...
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Results: Mean systolic arterial blood pressure of the study population was 135.85±15.27 and diastolic was 84.17±9.58mmHg. The parameters as PWV, AIx, CAP measured for arterial stiffness had correlations between BMI and different... more
Results: Mean systolic arterial blood pressure of the study population was 135.85±15.27 and diastolic was 84.17±9.58mmHg. The parameters as PWV, AIx, CAP measured for arterial stiffness had correlations between BMI and different anthropometric measurements. The statistically significant correlations was present between PWV and triceps skinfold thickness (TST) (r = 0.377, p < 0.001) and it was also seemed at regression analysis [PWV= 6.41 + (0.072×TST); R2 =0.142, F(1–98) = 16.23, p < 0.001]. Conclusions: Triceps skinfold thickness among this correlations may be used to estimate carotid-femoral pulse wave velocity which is an indicator of subclinical organ damage due to hypertension.
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Objective To compare the use of thermoreactive nitinol clips with the classic Robicsek technique for treatment of sternal dehiscence after cardiac surgery. Methods Eighty-two (2.3%) of 3564 open heart surgery patients underwent... more
Objective To compare the use of thermoreactive nitinol clips with the classic Robicsek technique for treatment of sternal dehiscence after cardiac surgery. Methods Eighty-two (2.3%) of 3564 open heart surgery patients underwent reoperation for sternal dehiscence between October 2011 and 2012. Prospectively collected data from 26 (31%) consecutive patients who underwent reoperation using thermoreactive nitinol clips were compared with those of a retrospective cohort of 42 (51.2%) who were treated with the classic Robicsek technique. To overcome baseline and operative variations, we constructed a propensity model using logistic regression. Results Overall mortality occurred in 3 (5%) patients and a second revision was performed in 2 (7.7%) in the nitinol clip group and 2 (6.3%) in the control group ( p &gt; 0.05). Postoperative results were similar except for the mean time of operation which was significantly shorter in the nitinol clip group, and patients in this group required substernal dissection slightly less frequently than those in the control group. Conclusions Thermoreactive nitinol clips allow the surgeon to perform a rapid and less challenging technique for sternal reoperations, without additional complications. Using this technique in an identical group with a finite sample size, we accomplished similar early results to those of the classic Robicsek technique.
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From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were... more
From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were diagnosed as a component of multi-organ echinococcosis and three of them underwent operation before. They were examined serologically and echocardiographically. Cardiac hydatidosis were diagnosed in right ventricle (in three cases), left ventricle (in one case), and interventricular septum (in two cases). Sternotomy was the approach used and all patients were operated on using cardiopulmonary bypass. Intraoperative rupture did not occur. There was no operative mortality, the only morbidity was complete atrioventricular block necessitating VVD pacemaker implantation in the patient with hydatid cyst involving the basal interventricular septum. All patients were followed by medical treatment with albendazole (400 mg/day) and no recurrences were reported in the late follow-up.
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Recently, coronary artery stenting has been successful when used as an intervention for percutaneous coronary artery disease. However, the procedure may frequently produce complications. Although rare, stent dislodgement is one such... more
Recently, coronary artery stenting has been successful when used as an intervention for percutaneous coronary artery disease. However, the procedure may frequently produce complications. Although rare, stent dislodgement is one such complication, which may result in serious problems including coronary artery dissection, myocardial infarction, peripheral embolisation and death. Stent dislodgement is known to be an early complication of the coronary artery stenting procedure. In this case report, we present a 53-year-old male with late coronary stent dislodgement. To the best of our knowledge, no such case has been addressed in the literature to date.
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... Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniği, İstanbul. Anahtar Kelimeler: Anastomoz, cerrahi; anevrizma, diseksiyon/ cerrahi; aort anevrizması, abdominal/cerrahi; aort anevrizması ...
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Background: Aortic dissection is associated with high mortality. Despite its rarity, it is often fatal. Aim: We have retrospectively analysed acute aortic dissections occurring intraoperatively (IAAD). Methods: Patients' preoperative risk... more
Background: Aortic dissection is associated with high mortality. Despite its rarity, it is often fatal. Aim: We have retrospectively analysed acute aortic dissections occurring intraoperatively (IAAD). Methods: Patients' preoperative risk factors, and operative and postoperative courses were analysed from the hospital records retrospectively. Results: From 1985 to 2009, we performed 29 683 cardiac operations. Ten patients (0.43 per thousand) (mean age 66.5+/-7 years) were diagnosed with IAAD. There were type 2 dissections in 9 and one patient had it extending beyond the arcus. Four patients were operated on for coronary artery disease, 2 for mitral and 2 for aortic valve diseases. Two patients had concomitant valvular or valvular and coronary procedures. IAAD was identified after decannulation in 5, after creating the holes for proximal anastomoses in 3 and after declamping the aorta in 2 patients. Preoperatively, 6 (60%) patients had hypertension and 4 had hypercholesterolaemia (40%). No other significant risk factors could be identified. Hypothermic circulatory arrest was used in 6 operations. The dissected segment was replaced with a graft in 9 patients whereas the remaining patient had concomitant arcus aorta replacement and elephant trunk procedure. Aortoplasty with Dacron patch was used in one patient. All patients required inotropic and 4 patients IABP support postoperatively. Three (30%) patients died. Conclusions: The IAAD may occur in any patient at any phase of cardiac surgery. The surgeon should always be aware of the possibility of this complication. It is much better to prevent the IAAD than to treat it. When detected, abrupt change of the operation plan and reparative measures for the dissection should be undertaken.
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Due to ventricular compensatory mechanisms, patients with severe aortic regurgitation are generally asymptomatic. Severe left ventricular dysfunction develops annually in 20% of non-operated cases, and the prognosis in those cases is... more
Due to ventricular compensatory mechanisms, patients with severe aortic regurgitation are generally asymptomatic. Severe left ventricular dysfunction develops annually in 20% of non-operated cases, and the prognosis in those cases is poor. Although surgery is recommend in patients with left ventricular dysfunction, surgeons are wary. We investigated the changes in ventricular and effort capacity after surgery in patients with normal and abnormal left ventricular function. We retrospectively examined the data of patients with aortic regurgitation who underwent aortic valve replacement in our clinic between 1993 and 2013. Those who had previous cardiac surgery, chemotherapy, radiotherapy, renal dysfunction, diabetes mellitus, or preoperative arrhythmias were excluded. The 113 patients were divided into 2 groups according to ejection fraction. In patients with ejection fraction &amp;amp;amp;amp;amp;amp;lt;50%, interventricular septal thickness, posterior wall thickness, and left ventricular mass were significantly greater than in the ejection fraction ≥50% group (p &amp;amp;amp;amp;amp;amp;lt; 0.01). No significant differences in intensive care unit stay and hospitalization were determined. No mortality was observed. Ejection fraction and effort capacity increased significantly after aortic valve replacement in both groups, and interventricular septal thickness, posterior wall thickness, and left ventricular mass decreased in both groups. Significant left ventricular functional improvements can be achieved after aortic valve replacement in patients with severe aortic regurgitation who develop left ventricular dysfunction. Despite the reported higher surgical mortality in this patient group, surgical treatment offers a survival benefit. We recommend surgical treatment in patients with severe aortic regurgitation who develop left ventricular dysfunction.
Research Interests: Cardiology, Treatment Outcome, Medicine, Humans, Internal Medicine, and 15 moreFemale, Male, Left Ventricular Dysfunction, Middle Aged, Adult, Time Factors, Retrospective Studies, Ventricular Remodeling, Ejection Fraction, Asymptomatic, Severity of Illness Index, Recovery of Function, Heart Valve Prosthesis Implantation, Aortic Valve Replacement, and Cardiovascular medicine and haematology
... Mid-term results of surgical radiofrequency ablation for permanent atrial fibrillation Dr. İlker Mataracı, Dr. Adil Polat,1 Dr. Bülent Mert,2 Dr. Mehmet Aksüt, Dr. Kaan Kırali ... Lojistik regresyon analizinde erken ve geç dönemde AF... more
... Mid-term results of surgical radiofrequency ablation for permanent atrial fibrillation Dr. İlker Mataracı, Dr. Adil Polat,1 Dr. Bülent Mert,2 Dr. Mehmet Aksüt, Dr. Kaan Kırali ... Lojistik regresyon analizinde erken ve geç dönemde AF geli-şim riskini artıracak bir faktör saptanmadı. ...
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... Ancak kötü olan vakalarda “patch plasty&amp;amp;amp;amp;#x27;&amp;amp;amp;amp;#x27; uygulandı. Yirmibeş olguda embolektomiyle beraber femoral artere endarterektomi ve safen “patch... more
... Ancak kötü olan vakalarda “patch plasty&amp;amp;amp;amp;#x27;&amp;amp;amp;amp;#x27; uygulandı. Yirmibeş olguda embolektomiyle beraber femoral artere endarterektomi ve safen “patch plasty&amp;amp;amp;amp;#x27;&amp;amp;amp;amp;#x27; yapıldı. ... Damar Cer Derg 1995;4:91-6. 21) Türkçapar AG, Erverdi N, Tüzüner A, Erdem E. Üst ekstremite tromboembolileri. ...
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... Cardiac pacing following surgery for acquired heart disease. J Card Surg 1996;11:332-40. 8) Ceviz M, Kocak H, Basoglu A, Sahin M, Cerrahoglu M, Ates A, et al. Post-CABG conduction disturbances. Ann Thorac Surg 1995;59:546-7. ...
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Çeşitli etiolojik faktörlere bağlı olarak gelişen son dönem kalp hastalıkları günümüzde ciddi bir sorun olmaya devam etmektedir. Medikal tedavisi mümkün olmayan veya konvansiyonel cerrahi endikasyonların dışında kalan ciddi kalp... more
Çeşitli etiolojik faktörlere bağlı olarak gelişen son dönem kalp hastalıkları günümüzde ciddi bir sorun olmaya devam etmektedir. Medikal tedavisi mümkün olmayan veya konvansiyonel cerrahi endikasyonların dışında kalan ciddi kalp yetersizliklerinin tedavisinde ilk seçenek kalp ...
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Objective: Since the angiotensin-converting enzyme (ACE) is the functional receptor for SARS-CoV-2, predominantly expressed by the alveoli, SARS-CoV-2 primarily involves the lungs. Aside from the lungs, ACE is expressed in other organs,... more
Objective: Since the angiotensin-converting enzyme (ACE) is the functional receptor for SARS-CoV-2, predominantly expressed by the alveoli, SARS-CoV-2 primarily involves the lungs. Aside from the lungs, ACE is expressed in other organs, including the thyroid gland. This study aimed to evaluate the incidence of thyroid dysfunction (TD) in patients admitted to the intensive care unit (ICU) with critical COVID-19, with inflammatory markers and disease severity, compared to patients with normal thyroid function. Materials and Methods: This retrospective study included 52 patients admitted to the ICU with PCR-confirmed critical COVID-19 between April 2020 and September 2021. Thyroid function tests were obtained within the first three days after ICU admission. TD was defined as the detection of any abnormal level in thyroid-stimulating hormone (TSH), free thyroxine hormone (FT4), and free triiodothyronine hormone (FT3). None of the patients had a prior history of thyroid disease or receiv...
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Recently, coronary artery stenting has been successful when used as an intervention for percutaneous coronary artery disease. However, the procedure may frequently produce complications. Although rare, stent dislodgement is one such... more
Recently, coronary artery stenting has been successful when used as an intervention for percutaneous coronary artery disease. However, the procedure may frequently produce complications. Although rare, stent dislodgement is one such complication, which may result in serious problems including coronary artery dissection, myocardial infarction, peripheral embolisation and death. Stent dislodgement is known to be an early complication of the coronary artery stenting procedure. In this case report, we present a 53-year-old male with late coronary stent dislodgement. To the best of our knowledge, no such case has been addressed in the literature to date.
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Paravalvular leak (PVL) is a complication of valve replacement surgery which may lead to serious clinical consequences including hemolytic anemia. This study aimed to retrospectively evaluate the effect of successful intervention on serum... more
Paravalvular leak (PVL) is a complication of valve replacement surgery which may lead to serious clinical consequences including hemolytic anemia. This study aimed to retrospectively evaluate the effect of successful intervention on serum lipid parameters in patients with PVL. A total of 106 patients (mean age: 57.2 ± 13.6 years, male: 67) who underwent surgical or transcatheter closure for symptomatic PVL were enrolled in this study. During the follow-up period, hemolysis and lipid parameters were evaluated at each clinical visit. This is the first study describing the effects of PVL on lipid metabolism after surgical or transcatheter closure. In the study, 18 patients (17%) had aortic PVL, 84 patients (79%) had mitral PVL, and 4 patients (3.8%) had both aortic and mitral PVL. A total of 59 patients underwent transcatheter closure and 47 patients were treated surgically. Technical success of the procedures was 83%. After successful PVL closure, hemoglobin and haptoglobin levels increased significantly (9.5 ± 1.3 vs 11.9 ± 2.1 g/dl, p <0.001 and 16.6 ± 7.9 vs 34.1 ± 19.9 mg, p <0.001, respectively). A significant increase in total cholesterol (158.9 ± 42.7 vs 209.3 ± 58.7 mg/dl, p <0.001), low-density lipoprotein cholesterol (99.1 ± 33.8 vs 133.9 ± 45.7 mg/dl, p <0.001), and high-density lipoprotein cholesterol (39.8 ± 12.4 vs 44.8 ± 11.7 mg/dl, p <0.001) levels was observed after successful PVL closure. In conclusion, symptomatic patients with PVL had hypocholesterolemia, reflected by low serum lipoprotein levels. After successful PVL closure, an increase in serum lipoprotein levels was observed. The recovery in levels of lipoproteins could be used as a marker of successful PVL closure, and absence of recovery of lipoprotein levels may indicate incomplete closure.